Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age

ABSTRACT– The prevalence of mental disorders in a representative sample of old people in Gothenburg, Sweden, was studied at 70, 75 and 79. The study comprised 392 subjects at 70, 302 subjects at 75 and 203 at 79. A case was defined by cut-off points on symptom and sign rating scales, and diagnoses were defined operationally as closely as possible to the ICD-classification. The total psychiatric morbidity was 21.9, 24.2 and 31.0% in the three age groups. The prevalence of schizophrenic and paranoid syndromes was 0.5, 1.7 and 2.5% and of affective disorders 1.0, 2.3 and 0.5%. The prevalence of dementias of psychotic degree was 1.3, 2.3 and 6.9% and of asthenic neuroses corresponding to dementias of mild-moderate degree 2.3, 4.0 and 9.4%. The prevalence of anxiety, depressive and obsessive-compulsive neuroses of moderate-severe degree was 6.6, 4.6 and 3.9% and of mild degree 7.9, 6.0 and 5.9%. The prevalence of active alcoholism in men was 4.2, 3.4 and 3.0% and in women 0.0% in all age groups. Current treatment was reported by 67–85% of subjects with psychoses, about one half of them in psychiatric services, and by 35–65% of subjects with neuroses, about one fifth of them in psychiatric services.     

The incidence of first-onset psychotic symptoms and paranoid ideation in a representative population sample followed from age 70-90 years. Relation to mortality and later development of dementia

BACKGROUND: Limited data are available on the incidence of psychotic symptoms in the elderly. OBJECTIVE: To elucidate the incidence of first-onset psychotic symptoms in the elderly and their relation to mortality and later development of dementia. METHOD: A population-sample (n = 392) born 1901-1902 was assessed from age 70-90 with psychiatric examinations, medical record reviews and from age 85, also with key-informant interviews. Individuals developing dementia were excluded. RESULT: The cumulative incidence of first-onset psychotic symptoms was 4.8% (8.0% including key-informant reports in the total sample) and 19.8 % in those who survived to age 85. Sixty-four percent of those with first-onset hallucinations later developed dementia, compared to 30% of those with delusions and 25% of those without psychotic symptoms. CONCLUSIONS: One fifth of non-demented elderly who survives up to age 85 develops first-onset psychotic symptoms. Hallucinations predict dementia, but most elderly individuals with first-onset psychotic symptoms do not develop dementia.     

Five-year incidence and prediction of dementia and cognitive decline in a population sample of women aged 70–79 at baseline

Objective. To determine the incidence of dementia and cognitive decline and their predictors in a population sample. Settings. A rural geographically defined population served by a single health centre. Sample. 75% of the 70–74-year-old, 100% of the 75–79-year-old women registered with the practice. Method. Interview the total sample using an augmented version of CAMDEX, including informant interview, and reaction times at baseline and 5 years later. IQ was estimated at baseline only. Results: 365 women were interviewed at baseline, 237 at follow-up. Incidence of dementia of all severities was 3.1% per annum (95% CI, 2.2–4.3). CAMCOG declined by 12.6 points in those who became demented, MMSE by 3 points. Observed, self-reported and informant-reported cognitive difficulty at baseline all predicted later incidence of dementia. The additional use of estimated IQ and reaction times did not increase the efficiency of either cross-sectional detection of dementia or prediction of dementia at 5 years. Conclusions. The incidence of dementia was in the range reported by other studies; slight cognitive decline was noted in the total population, increasing with age and marked in incident dementia. Of clinical importance was the finding that both the individuals and the informants of those who subsequently demented were aware of decline 5 years earlier. Simple and relatively easily administered cognitive tests were found to be the most efficient method of detection of dementia. © 1997 John Wiley & Sons, Ltd.     

Incidence of dementia in a Munich community sample of the oldest old

In a two-wave community study a representative sample of 402 very old people (older than 85 years) was restudied 1 year later. Four instruments in the clinical examination were used for case identification: (a) the Geriatric Mental State Interview (GMS-A); (b) the Structured Interview for the Diagnosis of Dementia (SIDAM); (c) the Global Deterioration Scale (GDS); and (d) the Mini Mental State Examination (MMSE). The clinical examination was performed by the interviewing physician who made a diagnosis according to DMS-III-R. The focus of the present study is on the (true) incidence of dementia in a representative community sample. The establishment of incidence rates is particularly important for dementia because the prevalence of dementia is affected by the length of survival, which is reducd in dementia and with increasing age. The annual incidence rates per 1000 person years on the basis of the SIDAM DSM-III-R were 116.6 for all cases at risk, 113.6 for those aged 85–89 years, 112.5 for those aged 90–94 years and 235.7 for those aged 95 years and older at first assessment (t₁). Incidence rates based on the other methods of assessment are reported. In order to obtain the most meaningful estimate of incidence rates a compound dementia diagnosis was defined. According to this the annual incidence rate per 1000 person years was 144.1 for all persons at risk. The incidence rate tended to be higher in the older-age cohorts: It was 126.2 for those aged 85–89 years, 193.1 for those aged 90–94 years and 295.5 for those aged 95 years and older. In comparison with the literature the incidence rates were high. The results are plausible when the very old age of the sample is taken into account.     

Incidence of dementia after age 90 in a multiracial cohort

Introduction

Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence.

Incidence and lifetime risk of dementia and Alzheimer's disease in a Southern European population

Lobo A, Lopez‐Anton R, Santabárbara J, de‐la‐Cámara C, Ventura T, Quintanilla MA, Roy JF, Campayo AJ, Lobo E, Palomo T, Rodriguez‐Jimenez R, Saz P, Marcos G. Incidence and lifetime risk of dementia and Alzheimer’s disease in a Southern European population. Objective: To calculate both the incidence rates and the lifetime risk (LTR) of dementia and Alzheimer’s disease (AD). Methods: A two‐phase case‐finding procedure was implemented in a cohort of 4057 cognitively intact individuals 55+ years of age living in Zaragoza, Spain, and followed‐up at 2.5 and 4.5 years. Age‐ and sex‐specific incidence rates were calculated. A mortality‐adjusted, multivariate model was used to document LTRs. Results: The incidence rate of dementia continued to rise after the age of 90 years, but was slightly lower than in North and West European studies. Only a tendency for an increased LTR with age was observed. Thus, LTR was 19.7% for a 65‐year‐old woman and 20.4% at the age of 85 years, the corresponding figures for AD being 16.7% and 17.6%. The LTR of AD was higher in women and was about twice as high among illiterate individuals when compared with individuals with higher educational levels. Conclusions: The incidence rate of dementia in this Southern European city was slightly lower than in previous studies in North‐West Europe. LTR of dementia and AD seems to be slightly increased with age. The association of illiteracy with higher LTR of AD is intriguing.     

Incidence of dementia and associated risk factors in Japan: The Osaki-Tajiri Project

The incidence of dementia and risk factors has not been fully investigated in Japan. Following a prevalence study in 1998, we investigated the incidence and associated factors in the same population in 2003 and 2005. Randomly selected 771 residents in Tajiri were targeted. The final participants included 204 (65.2%) healthy older adults (Clinical Dementia Rating, CDR 0) and 335 (73.1%) people with questionable dementia (CDR 0.5). We analyzed the incidence of dementia and dementing diseases, and possible risk factors. The risk factors included demographics, lifestyle-related factors, vascular risk factors, cognitive functions, and MRI findings. Overall, 3.9% of the CDR 0 and 37.0% of the CDR 0.5 participants developed dementia during the 5-year period, whereas 40.2% of the CDR 0.5 participants developed dementia during the 7-year period. Older adults had a higher incidence. Higher CDR Box scores had a higher incidence. Of the dementing diseases, 60.8% of participants developed Alzheimer' disease (AD), followed by vascular dementia (VaD), 17.9%. Logistic regression analyses showed that age, MMSE, cognitive functions such as recent memory, and generalized atrophy were significant predictors of progression to AD. Similarly, predictive factors for progression to VaD were age, MMSE, cognitive functions such as frontal function, and white matter lesions and cerebrovascular diseases. A comprehensive system including CDR, cognitive tests, and MRI, is recommended in community-based health policy planning.     

Mortality in relation to dementia,depression and social integration in an elderly community sample

In a community sample of 274 persons aged 70 + years in 1982-83, measures of depression, dementia and social integration made at that time were examined in relation to mortality in the following five years. The probability of death was increased in those diagnosed as having a dementia or a depressive disorder. The association between depression and mortality suggests that there may in such cases be a physical illness accompanied by a drop in mood. Alternatively, the symptoms of depression could also be symptoms of serious medical illness. Other symptoms, typical only of depression, did not predict mortality. There was no association between mortality and social integration, a finding which is contrary to previous observations.     

城乡社区≥55岁人群、可疑痴呆和痴呆患者死亡率及生存率的研究

目的　了解社区≥ 5 5周岁人群、可疑痴呆和痴呆患者的死亡率及生存率。方法　在1997年调查成都地区城乡社区≥ 5 5周岁人群 5 35 3人中痴呆患病率的基础上 ,于 2 0 0 0年用随机整群抽样方法抽取 384 1人调查其死亡及生存情况。在 384 1人中随访到 30 5 8人 ,死亡 391人 ,外出或迁出 392人。基线调查用美国精神障碍诊断与统计手册第 3版修订本的标准诊断痴呆 ,用临床痴呆程度评定量表评定痴呆程度。结果　 (1)基线调查时被评为筛查阴性、复查正常、可疑痴呆和痴呆的患者 ,3 3年后随访时的死亡率分别为 2 9% (2 35人 )、6 2 % (85人 )、15 0 % (19例 )和 2 8 5 % (5 2例 )。其中阿尔茨海默病 (AD)、血管性痴呆 (VD)和其他类型痴呆 (OD)患者死亡率分别为 2 8 8% (40例 )、33 9% (8例 )和 19 9% (4例 )。 (2 )筛查阴性、复查正常、可疑痴呆和痴呆患者的生存率分别为90 5 %、81 8%、6 0 0 %和 37 6 % (χ2 =36 1 31,P <0 0 0 1)。从发病时起 ,AD、VD、OD的 5 0 %生存率时间分别为 7 0年、4 2年、10 3年。结论　痴呆患者死亡率高 ,可疑痴呆者次之 ,正常人最低 ;而生存率则相反。VD患者的死亡率高于AD和OD患者且存活期短。     

Prevalence of dementia with Lewy bodies in an inpatient psychogeriatric population in Hong Kong Chinese

OBJECTIVE: To find out the prevalence of dementia with Lewy bodies (DLB) in an inpatient psychogeriatric population in Hong Kong Chinese. METHOD: Clinical notes of all dementia patients admitted to an inpatient psychogeriatric unit between 1 January and 31 December 2000 were reviewed to retrieve information on various subtypes of dementia that have been diagnosed prospectively using NINCDS-ARDRA, NINDS-AIREN, CDLB and DSM-IV by qualified senior psychogeriatricians. RESULT: There were only three cases of dementia with Lewy bodies out of 102 dementia inpatients, giving a prevalence rate of 2.9% over a two-year period. CONCLUSION: The prevalence rate of dementia with Lewy bodies is remarkably lower than figures reported in western studies. Further evaluation using better sampling frame and better-validated diagnostic gold standard is required. Ethnically related biological factors may be implicated to explain the preliminary low prevalence rate in Chinese population.     

The prevalence of dementia in a sample of elderly norwegians

A total of 1029 elderly persons aged 75 years and above, selected at random from two different samples, were examined to estimate the prevalence rate of dementia in the elderly. Of these, 334 were living at home, 518 in nursing homes, and 177 in homes for the aged. Dementia was diagnosed according to DSM-III. The estimated prevalence rate for the total population aged 75 years and over was 16.3%, slightly higher in women (16.5%) than in men (15.8%). Nearly half (7.8%) lived in institutions, mainly in nursing homes. In the sample living at home, the prevalence rate was 10.5%, in the nursing homes 71.6%, and in the homes for the aged 22.6%. In subjects living in nursing homes, the prevalence rate was significantly higher in women, 77.8%, then in men, 54.1%.     

The distribution of dementia,depression and neurosis in elderly men and women in an urban community: Assessed using the GMS–AGECAT package

A computerized diagnosis, AGECAT, is applied to data from random community samples of elderly people in New York and London in order to examine the distribution of mental illness between males and females. The greater proportion of dementia in females is confirmed for all AGECAT's levels of diagnostic confidence, and for depression at all levels except one. Age- and sex-specific prevalence rates are quoted for each half decade between 65 and 90 years. Differences between the sexes on syndrome case and subcase levels of neurotic disorder do not reach statistical significance.     

广州市城乡65岁及其以上人群痴呆患病率调查

目的调查广州市城乡≥65岁人群痴呆的患病率。方法采用分层随机整群抽样方法对广州市城乡人群进行抽样，用筛查和确诊两阶段法进行调查，实查14个居委会、2个村委会中≥65岁人群共3780人。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆，阿尔茨海默病（AD）诊断采用美国神经病学、语言障碍和卒中研究所及阿尔茨海默病与相关障碍协会的标准。结果（1）查出痴呆患者182例，粗患病率为4．81％；其中AD128例（3．39％），血管性痴呆（VD）44例（1．16％）；经2000年广州市人口年龄构成进行标化，痴呆、AD和VD患病率分别为4．54％、3．17％和1．11％。（2）女性痴呆患者134例，粗患病率（5．98％）高于男性（48例，3．12％；P〈0．001），经年龄标化患病率分别为6．03％和2．74％。（3）痴呆患病率随年龄增长急剧上升。结论广州地区年龄≥65岁老人的痴呆患病率为4．81％，AD患病率高于VD。老年期痴呆患病率随年龄的增长而急剧升高。     

Prevalence of moderate and severe Alzheimer dementia and multi-infarct dementia in the population of southeastern Sicily

We have calculate the prevalence rates of moderate and severe dementia of the Alzheimer type (DAT) and of multi-infarct dementia (MID) in a Sicilian population sample aged 40 and over. For DAT the prevalence rate is 0.80% among the over 40s and 2.42% among the over 65s. The prevalence rates for both types, but especially for DAT, increase higher prevalence of primary degenerative dementia among females.

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Sommario Abbiamo calcolato i tassi di prevalenza della demenza tipo Alzheimer e della demenza multiinfartuale di grado moderato e severo in un campione di popolazione siciliana di 40 anni ed oltre (4337 individui). Per la DAT il tasso di prevalenza è dello 0,80% [LF al 95% 0,56–1,11] nella popolazione di 40 anni ed oltre e diventa pari al 2,42% [LF al 95% 1,69–3,37] nella popolazione che ha raggiunto e superato il 65esimo anno di età.Per la MID la prevalenza è di 0,34% [LF al 95% 0,19–0,56] nella popolazione di 40 anni ed oltre, mentre nella popolazione di 65 anni ed oltre la prevalenza è dello 0,95% [LF al 95% 0,50–1,62].La prevalenza dei due tipi di demenza, e per quella tipo Alzheimer in particolare, aumenta significativamente con l'età. Altrettanto significativa è, sempre per la demenza degenerativa primaria, la più elevata prevalenza nel sesso femminile.

     

广州市城乡养老院60岁及其以上人群痴呆检出率的调查

目的调查广州市城乡养老院老年人痴呆患病情况。方法采用分层整群抽样方法，将广州地区养老院分为市级、区级、民营、厂矿及农村乡镇，每层各抽取1个养老院进行调查。应查者为抽中养老院的人住者，年龄≥60岁。实查1105人，失访12人（1．07％）。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆。结果（1）检出率：在1105名老人中，查出痴呆患者324例，检出率为29．32％。其中阿尔茨海默病（AD）为20、36％（225例）、血管性痴呆（VD）为7、69％（85例）、混合性痴呆为0145％（5例）、帕金森病痴呆为0．27％（3例）、其他类型痴呆为0、54％（6例）。（2）女性痴呆患者235例，检出率（31．8％）高于男性（89例，24．3％；P〈0．05）。（3）痴呆检出率随年龄增长而上升。（4）痴呆患者中轻度71例（占21、9％）、中度103例（占31．8％）、重度150例（占46．3％）。结论广州地区养老院老人的痴呆检出率为29．32％，其中AD检出率高于VD，女性高于男性，以重度者多见，且痴呆检出率随年龄的增长而升高。     

Incidence of major depression in a very elderly population.

BACKGROUND: Depression is considered to be a major health problem in the elderly. Due to methodological problems, there are few studies on the incidence of depression in old age. The present study examines the prevalence of depression in a 3-year follow-up study of a non-depressed very elderly population, thus estimating the incidence. METHODS: 875 non-depressed persons with a mean age of 85 years were extensively examined by physicians twice with a 3-year interval. Depression diagnosis was made according to DSM-IV. All persons with a history of depression or a current depression were excluded in order to estimate the first incidence. RESULTS: 4.1% of the population was diagnosed as having a depression at the follow-up examination. The estimated first incidence was 1.4% per person year (0.8% in males and 1.5% in females). Characteristics at baseline correlated with the onset of depression were: having a dementia, insufficient social network and having more than two depressive symptoms. CONCLUSIONS: The incidence of depression was slightly lower in this very elderly population than for younger age groups, but followed the same female to male ratio.     

Incidence of multiple sclerosis in the United Kingdom

Existing data on the incidence of multiple sclerosis (MS) in the UK have some limitations. Few studies have reported age- and sex-specific incidence rates of MS, and none of those is based on a large sample of the general population. Further, no published reports have provided age- and sex-specific incidence rates of MS by clinical course from onset. To estimate the age- and sex-specific incidence rate and lifetime risk of multiple sclerosis, we identified all new cases of MS during the period 1993–2000 in the General Practice Research Database, which includes health information on over three million Britons. Based on 642 incident cases, incidence rates of MS adjusted to the world population were 7.2 (95 % CI 6.5, 7.8) in women and 3.1 (95 % CI 2.6, 3.5) in men. The incidence of MS with relapsing-remitting onset was higher in women than in men (incidence rate ratio 2.5, 95% CI 2.1, 3.1), but there were no sex differences for primary-progressive MS (incidence rate ratio 1.1, 95% CI 0.7, 1.8). The estimated lifetime risk from birth of receiving an MS diagnosis was 5.3 per 1,000 in women and 2.3 per 1,000 in men. These results confirm the relatively high incidence of MS in the UK and show marked differences in the sex-specific pattern of MS incidence by clinical course from onset.     

Error-monitoring in an everyday task in people with Alzheimer-type dementia: Observations over five years of performance decline

Research suggests that, although everyday action errors increase significantly with dementia progression, accomplishment of the task remains high, even in severe dementia. We used archive observational data charting progressive decline in everyday task performance to explore error-monitoring over a 5-year period in four people with dementia. None of the participants showed effective error-monitoring during their execution of their established tea-making routine: Over 5 years and into more severe stages of dementia, errors increased, but there was no reactive increase from our participants in error-monitoring. Training to error-monitor routine tasks may be an appropriate target for further study.     

Help-seeking intentions for early dementia diagnosis in a sample of Irish adults

Objectives: To identify factors that may increase intentions to seek help for an early dementia diagnosis. Early dementia diagnosis in Ireland is low, reducing the opportunity for intervention, which can delay progression, reduce psychological distress and increase social supports.

Method: Using the theory of planned behaviour (TPB), and a mixed methods approach, three focus groups were conducted (N = 22) to illicit attitudes and beliefs about help seeking for an early dementia diagnosis. The findings informed the development of the Help Seeking Intentions for Early Dementia Diagnosis (HSIEDD) questionnaire which was piloted and then administered to a sample of community dwelling adults from Dublin and Kildare (N = 95).

Results: Content analysis revealed participants held knowledge of the symptoms of dementia but not about available interventions. Facilitators of help seeking were family, friends and peers alongside well informed health professionals. Barriers to seeking help were a lack of knowledge, fear, loss, stigma and inaccessible services. The quantitative findings suggest the TPB constructs account for almost 28% of the variance in intentions to seek help for an early diagnosis of dementia, after controlling for sociodemographic variables and knowledge of dementia. In the final step of the regression analysis, the main predictors of help seeking were knowledge of dementia and subjective norm, accounting for 6% and 8% of the variance, respectively.

Conclusion: Future interventions should aim to increase awareness of the support available to those experiencing early memory problems, and should highlight the supportive role that family, friends, peers and health professionals could provide.